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Table 4 Details of the diagnostic characteristics, descriptive values, and predictive value of the preoperative nuclear imaging examinations and postoperative liver failure

From: Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

Author Cut-off value (variable, value and unit) Liver failure vs. no liver failure (mean or median, p value) Key diagnostic characteristics Univariate predictive regression analysis (impact, p value) Multivariate predictive regression analysis (impact, p value)
Chapelle et al. [19] eFLRF, 2.3 (%/min/m2) 2.2 vs. 4.7 (p < 0.001) Sens 92%, spec 98%, PPV 92%, NPV 99% For eFLRF < 2.3: OR 836 (p < 0.001) NR (p = 0.001)
TLF, NR (%/min)1 5.0 vs. 6.2 (p = 0.020) NR NR (p = 0.027) NR (NS)
Chapelle et al. [21] eFLRF, 2.3 (%/min/m2) 3.3 vs. 8.4 (p < 0.001) AUC 0.843 NR (NR) OR 0.35 (p = 0.002)
HBSBSA, NR (%/min)1 5.5 vs. 6.1 (p = 0.057) AUC 0.652 NR (NR) NR (NR)
Chiba et al. [18] Remnant liver LU 15, 13 NR (NR) NR Cont. LU 15: OR 0.92 (NS)2
rLU 15 < 13: OR 81.8 (p < 0.001)2
Cont.: NR (NR)2
rLU 15 < 13: OR 67.7 (p < 0.001)2
Total liver LU 15, NR NR (NR) NR OR 0.97 (NS) NR (NR)
LHL15, NR NR (NR) NR OR 0.04 (NS) NR (NR)
HH15, NR NR (NR) NR OR 0.07 (NS) NR (NR)
Cho et al. [22] SUVmean, 2.4 2.1 vs. 2.3 (NS) Sens 100%, spec 32%, PPV 7%, NPV 100% For SUVmean ≤ 2.4: OR 7.0 (NS) NR (NR)
TLGr, 625.6 1067 vs. 1491 (NS) Sens 57%, spec 97%, PPV 44%, NPV 98% For TLGr ≤ 625.6: OR 36.5 (p < 0.001) For TLGr ≤625.6: OR 82.9 (p < 0.001)
de Graaf et al. [10] FRL-F, 2.69 (%/min/m2) 2.2 vs. 4.3 (p = 0.001) Sens 89%, spec 87%, PPV 57%, NPV 98% NR (NR) NR (NR)
Dinant et al. [24] FRL-uptake, 2.5 (%/min/BSA) 2.3 vs. 4.3 (p = 0.003) Sens 83%, spec 90%, PPV 56%, NPV 97% NR (p = 0.01) OR 4.0 (p = 0.03)
Hayashi et al. [28] Marginal FR function, NR (%) NR (NR) NR For marginal FR function vs. safe FR function: OR 11.0 (p = 0.001) NR (NR)
Hirai et al. [30] [99mTc]Tc-GSA uptake, 25% of non-embolized liver 10.0% vs. 25.8% (p = 0.02)3 Sens 50%, spec 94% NR (NR) NR (NR)
Hwang et al. [31] Predicted, residual [99mTc]Tc-GSA-clearance, NR (mL/min) 90 vs. 321 (p < 0.005) NR NR (NR) NR (NR)
Total [99mTc]Tc-GSA-clearance, NR (mL/min) 315 vs. 567 (NS) NR NR (NR) NR (NR)
Kaibori et al. [34] HA/GSA-Rmax ratio, 500 (mg min/dl) NR (p < 0.0001)4 Sens 88%, spec 92%, PPV 50%, NPV 99% For HA/GSA-Rmax ratio ≥ 500: OR 21.5 (p < 0.0001) For HA/GSA-Rmax ratio ≥ 500: OR 23.6 (p = 0.0138)
GSA-Rmax, 0.475 (mg/min) NR (p = 0.0016)4 NR For GSA-Rmax < 0.475: OR 8.1 (p = 0.0066) For GSA-Rmax < 0.475: OR 0.2 (NS)
Type IV collagen 7S/GSA-Rmax, 15 (mg min/dL) NR (p < 0.0001)4 NR For Type IV collagen 7S/GSA-Rmax ≥ 15: OR 18.1 (p = 0.0056) For Type IV collagen 7S/GSA-Rmax ≥ 15: OR 7.7 (NS)
Kato et al. [36] LHL15, NR 0.90 vs. 0.92 (p = 0.006) AUC 0.68 NR (NR) Per 0.1-unit increment: OR 0.24 (p = 0.046)
HH15, NR 0.66 vs. 0.63 (NS) NR NR (NR) NR (NR)
GSA-Rmax, NR 0.61 vs. 0.71 (p = 0.03) AUC 0.62 NR (NR) Per 0.1-unit increment: OR 0.81 (NS)
rERL-GSA, NR 0.53 vs. 0.60 (NS) AUC 0.62 NR (NR) NR (NR)
ERL-LHL15, NR 0.48 vs. 0.55 (p = 0.04) AUC 0.64 NR (NR) NR (NR)
ERL-Rmax, NR5 0.33 vs. 0.41 (p = 0.004) AUC 0.66 NR (NR) NR (NR)
Kim et al. ≠ [39] LHL15, 0.91 0.85 vs. 0.94.(p < 0.0001) NR NR (NR) NR (p < 0.0001)
Kokudo et al. [40]6 R0-remnant, 0.16 (μmoles) 0.015 vs. 0.024 (p = 0.011) NR NR (NR) Per 0.01 μmoles increment: HR 0.82 (p = 0.022)
LHL15, NR 0.89 vs. 0.93 (p = 0.025) NR NR (NR) NR (NS)
HH15, NR 0.58 vs. 0.52 (NS) NR NR (NR) NR (NR)
R0, NR (μmole) 0.14 vs. 0.18 (p = 0.038) NR NR (NR) NR (NS)
[R]0, NR (μM) 0.63 vs. 0.70 (NS) NR NR (NR) NR (NR)
Mao et al. [48] Uptake index, 0.97 NR (NR) Sens 100%, spec 92% NR (NR) NR (NR)
Nakamura et al. [50] LHL15, NR 0.875 vs. 0.903 (p = 0.015) NR NR (NR) OR 1.32 (NS)
Remnant LHL15, 0.755 0.739 vs. 0.791 (p = 0.009) NR NR (NR) OR 0.03 (p = 0.023)
Nakano et al. ≠ [51] GSA-Rmax, 0.60 NR (NS) NR NR (NR) NR (NS)
Nanashima et al. ≠ [54] LHL15, 0.875 NR (p < 0.001)4 NR NR (NR) NR (NR)
Nanashima et al. ≠ [55] LHL15, 0.85 91.1 vs. 93.1 (p = 0.014) NR NR (NR) For LHL15 < 0.85 vs. ≥ 0.85: OR 1.4 (NS)
Nanashima et al. ≠ [56] LHL15, 0.85 92.2 vs. 95.2 (p = 0.021) NR For LHL15 < 0.85 vs. ≥ 0.85: OR 5.1 (p = 0.022) For LHL15 < 0.85 vs. ≥ 0.85: OR 3.8 (NS)
Nanashima et al. ≠ [57] LHL15, 0.90 0.89 vs. 0.92 (p = 0.015) NR NR (NR) For LHL15 < 0.90 vs. ≥ 0.90: OR 2.7 (NS) (LF)
HH15, 0.60 (Y values of regression equation for LF only, 7.2) 0.61 vs. 0.58 (p < 0.01) NR NR (NR) For HH15 ≥ 0.60 vs. < 0.60: OR 3.3 (p = 0.045) (LF)
LHL15/HH15, 1.60 1.53 vs. 1.64 (p < 0.01) NR NR (NR) For LHL15/HH15 < 1.60 vs. ≥ 1.60: OR 0.9 (NS) (LF)
Nanashima et al. [59] LHL15/HH15, NR 1.52 vs. 1.64 (NS) NR NR (NR) NR (NR)
LHL15 minus HH15, NR 31.0 vs. 34.6 (NS) NR NR (NR) NR (NR)
Nitta et al. [62] Fvo-0%, marginal function8 NR (p = 0.031)4 C-index ≈ 0.67 NR (NR) NR (NS)
Fvo-40%, marginal function8 NR (p = 0.031)4 C-index = 0.737 NR (NR) For marginal vs. safe function: OR 9.0 (p = 0.002)
Fvo-100%, marginal function8 NR (p = 0.013)4 C-index ≈ 0.65 NR (NR) NR (NS)
Okabe et al. [64] LHL15, 0.939 0.92 vs. 0.93 (p = 0.0027) Sens 88%, spec 96% NR (NR) For LHL15 ≤ 0.93: OR 7.4 (p = 0.0082)
HH15, NR9 0.66 vs. 0.58 (p = 0.0041) NR NR (NR) NR (NR)
Olthof et al. [65] Total liver function, NR (%/min) 14.6 vs. 16.2 (p = 0.41) NR NR (NR) NR (NR)
FLR function, NR (%) 44.7 vs. 63.4 (p < 0.01) AUC 0.68 NR (NR) NR (NR)
FLR function, 8.5 (%/min) (new cut-off) 5.6 vs. 8.7 (p < 0.01) PPV 36%, NPV 91% (new cut-off)10
AUC 0.69
For FLR function < 8.5: OR 5.4 (p < 0.01) For FLR function < 8.5: OR 4.1 (p < 0.01)
sFLR function, 2.7 (%/min/m2) (predefined cut-off) 3.1 vs. 4.7 (p < 0.01) PPV 38%, NPV 82% (pre-defined cut-off)10
AUC 0.68
NR (NR) NR (NR)
Rassam et al. ≠ [67] FRL function, 2.7 (%/min/m2) (predefined cut-off) NR (NS) NR NR (NR) NR (NR)
MUR NR (%/min) NR (NS) NR NR (NR) NR (NR)
Satoh et al. ≠ [68] PRI, 0.38 NR (NR) PPV 71%, NPV 100% NR (NR) NR (NR)
Serenari et al. [69] FLR-C, 34.5 (%) 30 vs. 41 (p = 0.011) Sens 100%, spec 82%, PPV 50%, NPV 100% NR (NR) NR (NR)
FLR-F, 1.69 (%/min/m2) 0.94 vs. 2.07 (p = 0.011) Sens 100%, spec 75%, PPV 50%, NPV 100% NR (NR) NR (NR)
HIBA-i, 14.94 (%) 12.86 vs. 23.29 (p = 0.001) Sens 100%, spec 94%, PPV 80%, NPV 100% NR (NR) NR (NR)
Serenari et al. [70] FRL-F, NR (%/min/m2) 1.72 vs. 4.02 (NR) NR NR (NR) NR (NR)
Sugai et al. ≠ [73] LUR/ LUR response rate, NR (%/%) NR (NS) / NR (NS)11 NR NR (NR) NR (NR)
FV / FV response rate, NR (cm3/%) NR (NS)/NR (NS)11 NR NR (NR) NR (NR)
LUD/LUD response rate, NR (%/cm3/%) 0.035 vs. 0.064 (p < 0.05)/− 8.9 vs. 22.2 (p < 0.01)11 NR NR (NR) NR (NR)
Sumiyoshi et al. ≠ [74] remKGSA, 0.05 NR (p < 0.02) NR NR (NR) NR (NR)
KGSA, NR NR (NS) NR NR (NR) NR (NR)
Tanaka et al. [79] LHL15, NR NR (NR) NR NR (p < 0.001) NR (NR)
GSA-index, NR NR (NR) NR NR (p = 0.001) NR (NR)
Remnant VLmg, NR NR (NR) NR NR (p = 0.001) NR (NR)
Tanoue et al. [81] GSA-Rmax, NR (mg/min) 0.479 vs. 0.501 (NS) NR NR (NR) NR (NR)
rGSA-Rmax, NR (mg/min) 0.319 vs. 0.374 (p = 0.032) NR NR (NR) NR (NR)
Difference between GSA-Rmax and rGSA-Rmax, NR (mg/min) 0.160 vs. 0.127 (NS) NR NR (NR) NR (NR)
rGSA-Rmax/GSA-Rmax, NR 0.692 vs. 0.756 (p = 0.042) NR NR (NR) NR (NR)
Yano et al. [88] GSA-Rmax, NR (mg/min) 0.432 vs. 0.453 (NS) NR NR (NR) NR (NR)
Yoshida et al. [90] rLUV(BSA), 27.0%/BSA 23.0 vs 33.6 (p < 0.001)12 Sens 91%, spec 81%, PPV 31%, NPV 99% NR (NR) NR (p < 0.001)
HH15, NR 0.64 vs. 0.60 (p < 0.05)12 NR NR (NR) NR (NS)
LHL15, NR 0.90 vs. 0.91 (NS)12 NR NR (NR) NR (NR)
% remnant LF, NR (%) 60.9 vs. 75.3 (p < 0.001)12 NR NR (NR) NR (NS)
Yumoto et al. [93] R0-remnant, 100 (nmol/liver) 62.1 vs. 122.2 (p < 0.001) AUC 0.97 NR (NR) NR (NR)
[R]0, NR (nmol/l) 412 vs. 551 (p = 0.045) AUC 0.80 NR (NR) NR (NR)
R0, NR (nmol/liver) 149.8 vs. 211.2 (p = 0.047) NR NR (NR) NR (NR)
LHL15, NR 0.79 vs. 0.87 (p = 0.035) AUC 0.74 NR (NR) NR (NR)
  1. Papers with liver failure as part of a composite endpoint are marked with a “≠”; in those cases, the data are reported for overall complications in which liver failure is included unless otherwise stated (marked LF). For the diagnostic characteristics, sens, spec, NPV, and PPV were reported if available; otherwise, AUC was reported if available
  2. eFLRF estimated future remnant liver function, NR not reported, Sens sensitivity, Spec specificity, PPV positive predictive value, NPV negative predictive value, TLF total liver function, HBSBSA global liver function ([99mTc]Tc-mebrofenin hepatobiliary scintigraphy clearance divided by body surface area), SUVmean mean standardized uptake value, TLGr total glycolysis of the remnant liver, LU 15 the cumulative liver uptake of the tracer 15 to 16 min after injection of the tracer, Cont. continuous, LHL15 [99mTc]Tc-GSA receptor index, R0-remnant total hepatic asialoglycoprotein receptor amount in the future remnant liver, HH15 [99mTc]Tc-GSA clearance index, FRL-F future remnant liver uptake function, FRL future remnant liver, FR future remnant, HA/GSA-Rmax ratio the ratio of serum hyaluronic acid to the maximum removal rate of [99mTc]Tc-GSA, GSA-Rmax the maximum removal rate of [99mTc]Tc-GSA, Type IV collagen 7S/GSA-Rmax the ratio of type IV collagen 7S to the maximum removal rate of [99mTc]Tc-GSA, rERL-GSA ratio of preoperatively estimated remnant liver counts (ERL) to total liver counts, ERL-LHL15 hepatic uptake ratio (LHL15) of estimated remnant liver, ERL-Rmax maximal removal rate of estimated remnant liver counts, R0 total hepatic asialoglycoprotein receptor amount, [R]0 hepatic asialoglycoprotein receptor concentration, LHL15/HH15 GSA index, cICGR15 converted indocyanine green retention rate at 15 min calculated from HH15, LHL15, and hyaluronic acid level, Fvo presumed function of the veno-occlusive region of the liver, FLR future liver remnant, sFLR standardized future liver remnant, MUR the mebrofenin uptake rate, PRI predictive residual index, FRL-C percentage of counts within the future remnant liver, HIBA-i the HIBA-index (the proportion of radionuclide accumulated in the future remnant liver), LUR liver uptake ratio, FV functional liver volume, LUD liver uptake density, KGSA the estimated indocyanine green plasma clearance rate using the hepatic uptake ratio of [99mTc]Tc-GSA (LHL15), remKGSA KGSA of the future remnant liver, Remnant VLmg amount of [99mTc]Tc-GSA accumulation in the remnant liver, rGSA-Rmax the maximum removal rate of [99mTc]Tc-GSA in the remnant liver, rLUV(BSA) liver uptake value of the remnant liver corrected for body surface area, % remnant LF the relative residual liver function, (LF) for predicting LF exclusively
  3. 1TLF and HBSBSA corresponds to the same global liver function estimate from [99mTc]Tc-mebrofenin hepatobiliary scintigraphy, but in the two papers they are named differently
  4. 2They report both the predictive value of the continuous remnant LU 15 value and the predictive value of the cut-off of remnant LU 15 < 13. The latter resulting in a significant predictive value
  5. 3Before PVE
  6. 4Not a comparison of liver function uptake value between patients with liver failure or without but a comparison of LF rate in patients with liver uptake value above and below a certain value (cut-off)
  7. 5In addition to these GSA-parameters of liver function, they also report the diagnostic characteristics, cut-off value, predictive value in univariate and multivariate analysis of the actual remnant liver (ARL) GSA-parameters (rARL-GSA, ARL-LHL15, and ARL-Rmax) with updated delineations of the FLR based on the pre- and postoperative CT-scans. These are not shown in this table but can be found in the paper
  8. 6For “Signs of postoperative Liver Failure”
  9. 7For predicting patients with a postoperative Child score of ≥ 9, which corresponds to a high risk of liver failure
  10. 8They are all based on the liver uptake ratio of [99mTc]Tc-GSA
  11. 9Reported here for patients with a % FLR (volume-based) of 35–60%, further details are provided for patients > 60% FLR in the original paper
  12. 10In the whole patient population, not just in the patients with bilirubin level below 50 μmol/L at the time of hepatobiliary scintigraphy. For these patients the PPV 41%, NPV 94%
  13. 11Post percutaneous transhepatic portal embolization (PTPE) values listed here. The pre-PTPE values are also reported in the paper for the patient with and without complications, but not listed here
  14. 12Non-preserved vs. preserved liver function on postoperative day 5; non-preserved referring to moderate-severe hepatic dysfunction on postoperative day 5 and preserved referring to no or mild hepatic dysfunction on postoperative day 5